San Francisco Medical Monitoring Project (MMP) Maree Kay Parisi - PowerPoint PPT Presentation

San Francisco Medical Monitoring Project (MMP) Maree Kay Parisi Applied Research, Community Health Epidemiology and Surveillance

Medical Monitoring Project  Overview  National prospective  Local data and findings  Future of MMP

Medical Monitoring Project (MMP) Background  Supplemental surveillance system  Created in response to 2004 Institute of Medicine report  Need for population-based, nationally representative data on HIV-infected persons in care

Methods: MMP Design  Complex sample cross-sectional survey  17 states or territories sampled from 50 US states, Washington DC and Puerto Rico • Contain 73% of all adults diagnosed with HIV in the US  Outpatient HIV care facilities within sampled states or territories  HIV-infected adults receiving medical care during January-April within sampled facilities

MMP Participating Project Areas, 2009-2014 WA WA OR OR NY MI MI New York City San Francisco PA Philadelphia Chicago IN IL NJ CA VA VA DE Los Angeles County NC MS GA TX Houston FL PR

Methods: Data Collection  Interview: Self-reported demographics, experiences and behaviors  Medical record abstraction (MRA): Documented clinical care  Linkage to the National HIV Surveillance System (NHSS)  Minimum data set (MDS)  Facility characteristics  HIV provider survey

Collaborations CDC COLLABORATIONS EXTERNAL COLLABORATIONS Division of HIV/AIDS Prevention HIV Medicine Association (HIVMA)    HIV Incidence and Case American Academy of HIV  Surveillance Branch Medicine (AAHIVM)  Prevention Communication AIDS Education Training Centers  Branch (AETCs)  Prevention Research Branch Association of Nurses in AIDS Care  (ANAC)  Prevention Evaluation Branch Health Resources and Services  Epidemiology Branch  Administration (HRSA) Institute of Medicine (IOM)  Division of STD Prevention  Committee on Monitoring HIV Care White House Office of National  Division of TB Elimination  AIDS Policy (ONAP) Kaiser Family Foundation (KFF)  Office of Smoking and Health  Emory University School of Public  Health London School of Hygiene and  Tropical Medicine

Overview of San Francisco MMP 1464 total participants Facility type of participants 2007-2013 in San Francisco from 2007-2013 Year n Public 2007 147 hospital 2008 182 21% (n=313) 2009 212 2010 220 Public Private/ clinic 15% 2011 219 HMO 61% (n=219) (n=888) 2012 249 2013 235 VA 3% (n=44)

MMP patient characteristics 2009-2010 Weighted %* Male 93% Female 4% Transgender 3% 25-34 years 6% 35-44 years 22% 45-54 years 40% 55+ years 31% Any MSM (MSM only+MSMW) 84% MSW only 7% Any WSM (WSM only+WSMW) 4% White 57% African American 11% Hispanic 19% Other 13% Have continuous health coverage 92% At or below poverty level 11% Homeless 15% HIV diagnosis <5 years 13% HIV diagnosis 5-9 years 14% HIV diagnosis ≥ 10 years 73% *data were weighted to adjust for probability of selection and facility and patient nonresponse

ART, viral suppression and prevention counseling 2009-2010 Viral suppression Prevention counseling Prescription of among those on by a health care ART (%) ART (%) provider (%) Weighted %* Weighted %* Weighted %* 25-34 86% 68% 48% 35-44 83% 81% 44% 45-54 90% 85% 37% >=55 94% 90% 13% Male 90% 85% 30% Female 96% 72% 50% Black or African American 84% 76% 42% Hispanic or Latino** 83% 85% 41% White 93% 86% 25% Other 89% 86% 37% Men who have sex with men 90% 87% 29% Men who have sex with women only 89% 69% 44% Women who have sex with men 96% 72% 50% Total 90% 85% 32% *data were weighted to adjust for probability of selection and facility and patient nonresponse

Met and Unmet Needs for Services, 2009-2010 (N = 418) Dental Services Public benefits incl SSI/SSDI Mental Health Services AIDS Drug Assistance Program (ADAP) HIV Case Management Services Meals or food services Transportation Assistance Services HIV peer group support Services with the HIV prevention education largest unmet need Shelter services 1. Dental services Adherence services 2. HIV peer group support Drug or alcohol counseling/treatment 3. Mental health 4. Transportation services Home health services 5. HIV Case Management Domestic violence services Interpreter services Childcare Services 0 2000 4000 6000 8000 10000 12000 Met need Unmet Need

Is age associated with unmet need for supportive services among HIV-infected patients receiving HIV care? • 761 MMP participants in SF: 3% were ages 18-29, 13% were 30- 39 years, 39% 40- 49 years and 46% were ≥50 years old • 86% had at least one supportive service need and 45% had at least one unmet service need in the past 12 months • Age was not associated with need for any supportive service • Patients from public facilities and uninsured reported higher need for any supportive service.

Sexual Behavior, 2009-2010 (N = 418) 90% 83% 79% 80% 70% 67% 60% 50% 50% 44% 39% 40% 30% 22% 20% 18% 20% 11% 11% 10% 4% 0% Total MSM MSW WSM Any sex Unprotected sex Unprotected sex with HIV negative or unknown status partner

Percentage of Persons with HIV Engaged in Selected Stages of the Continuum of Care — United States 100 90 82 80 70 60 50 37 40 33 25 30 20 10 0 Diagnosed Retained in care Prescribed ART Viral suppression Hall et al. JAMA Int Med. 2013; DOI:10.1001/jamainternmed.2013.6841

Linkage, Retention, ART Use and Viral Suppression • Successful HIV treatment involves: – Timely linkage to medical care – Ongoing engagement in care – Access and adherence to effective HIV treatment

28% get to 80% viral suppression CDC. Vital signs: HIV prevention through care and treatment – United States. MMWR 2011; 60:1617-23.

Stages of HIV Care, San Francisco 100% (n=17,665) 18000 16000 80% (n=14,132) 14000 68% (n=12,012) Number of persons 12000 57% (n=10,034) 50% 10000 46% (n=8,930) (n=8,216) 80% 8000 85% 6000 71% 89% 92% 4000 2000 0 HIV-infected HIV Linked to In care On ART Suppressed Diagnosed care

Percentage of estimated number of HIV-infected persons* in stages of the continuum of HIV care in four large United States cities through December 2009 compared to national estimates; Chicago, Philadelphia, Los Angeles and San Francisco. 100% US (Total infected=1,178,350) 90% Chicago (Total infected=23,799) Percent of estinated total HIV-infected Los Angeles County (Total infected=47,658) 80% Philadelphia (Total infected=19,691) 68% 70% 62% 62% San Francisco (Total infected=17,665) 58% 60% 57% 54% 53% 50% 50% 47% 46% 41% 41% 39% 40% 36% 34% 31% 28% 27% 30% 26% 22% 20% 10% 0% Linked to Care In Care On ART** Suppressed viral load*** *Includes people diagnosed with and unaware of their HIV infection **Percent of people in care on antiretroviral therapy from Medical Monitoring Project *** Most recent HIV viral load test indicating <=200 copies/mL among those on ART from Medical Monitoring Project

Future of MMP  Case Surveillance Based Sampling (CSBS)  Sample is based on diagnosis date and last known residence  Potential to sample people who are out of care

Acknowledgements • SF MMP Team Susan Scheer, PhD, MPH Maree Kay Parisi Principal Investigator Project Coordinator Anthony Buckman, MS Patrick Norton, PhD, MA Anne Hirosawa, MPH Rolando Ramirez Alison Hughes, MPH Nashanta Stanley Patrick Norton, PhD, MA Maya Yoshida-Cervantes Kristiana Dhillon Zachary Matheson • All MMP participants and participating facilities • Andrew Lopez, SF MMP Community Advisory Board • Dr. Toby Dyner, SF MMP Provider Advisory Board